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General NPI Number Information
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NPI Number | 1194505941
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Entity Type | Individual
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Provider Name | SARAH WAGNER
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Gender | Female
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Dates
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Enumeration Date | 09/29/2023
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Last Update Date | 01/29/2026
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Provider Practice Location Address
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Address Line | 10941 RAVEN RIDGE RD STE 103
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City | RALEIGH
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State | NC
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Zip | 27614-6487
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Country | US
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Telephone | 919-870-6066
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Fax |
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Provider Business Mailing Address
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Address Line | 1041 SIDNEY CREEK DR
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City | ZEBULON
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State | NC
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Zip | 27597-4444
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Country | US
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Telephone | 252-808-5490
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 5018910
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License Number State | NC
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